Provider Demographics
NPI:1639640840
Name:FERNANDEZ, ARMANDO (MS, LEP)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 ELK GROVE FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1801
Mailing Address - Country:US
Mailing Address - Phone:916-686-7797
Mailing Address - Fax:
Practice Address - Street 1:9510 ELK GROVE FLORIN RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1801
Practice Address - Country:US
Practice Address - Phone:916-686-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2273103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool